ABSTRACT
Background: Wounds with bare bone, joint and tendons in the extremities have been a formidable challenge to plastic surgeons. Although several skin substitutes are used in West, as both dermal and epidermal analogue, they are expensive and most of them are unavailable in India. It is in this scenario that Healicoll – a type 1 pure collagen as a possible dermal substitute is being investigated. The material ‘Healicoll’ is a type-1 native collagen derived from the bovine source and is bioengineered, biocompatible and biodegradable skin substitute. The advantages of Healicoll have led us to an increase in its use for complex wounds. Medical literature on Healicoll, thus far has only reported its use for superficial burns and ulcers. Materials & Methods: The purpose of this study was to evaluate the advantages of using an inexpensive, easily available, bioengineered skin substitute ‘Healicoll’ for the closure of bare bone, joints and tendon. Results: Healicoll was used in three patients with two patients having undergone surgery involving use of Healicoll for bare bones, joints and tendons after release of contracture following burns and trauma, and one patient was treated with Healicoll as an outpatient procedure for bare bones following electrical burns. The mean hospital stay was 15 days. In all the three cases, a clear neodermis had covered the bones and joints in 5 days time and was ready to support the take of skin graft. Conclusions: Based on our initial experience, Healicoll skin substitute offers an excellent alternative for rapid reconstruction obviating the need for flap cover for wounds that have been difficult to reconstruct.
ABSTRACT
Fournier’s gangrene is a rare, idiopathic, life-threatening, necrotizing fasciitis of the genitals and perineum caused by both aerobic and anaerobic bacterial flora. The synergistic effect of the bacteriae results in fulminating gangrene, multiple organ failure, and can even lead to death. Most commonly it has a predilection for diabetic and alcohol abused individuals, those who have impaired immunity. Genital trauma is frequently recognized vector for infection initiation. Timely recognition of the disease process and initiation of treatment with aggressive debridement and antibiotic administration is called for. The advanced age of the patient, extensive disease, delayed presentation with shock or sepsis and organ failures, all contribute to mortality in Fournier’s gangrene. In this case report, we recall an account of our tryst with Fournier’s gangrene management.
ABSTRACT
BACKGROUND: The calcium channel blocker, verapamil stimulates procollagenase synthesis in keloids and hypertrophic scars. AIM: To study the effect of verapamil in the treatment of hypertrophic scars and keloids and to evaluate the effect of verapamil on the rate of reduction of hypertrophic scars and keloids in comparison with triamcinolone. METHODS: The study was a randomized, single blind, parallel group study in which 54 patients were allocated to to receive either verapamil or triamcinolone. Drugs were administered intralesionally in both groups. Improvement of the scar was measured using modified Vancouver scale and by using a centimeter scale serially till the scar flattened. RESULTS: There was a reduction in vascularity, pliability, height and width of the scar with both the drugs after 3 weeks of treatment. These changes were present at one year of follow-up after stopping treatment. Scar pigmentation was not changed desirably by either drug. Length of the scars was also not altered significantly by either drug. The rate of reduction in vascularity, pliability, height and width of the scar with triamcinolone was faster than with verapamil. Adverse drug reactions were more with triamcinolone than with verapamil. CONCLUSION: Intralesional verapamil may be a suitable alternative to triamcinolone in the treatment of hypertrophic scars and keloids.